Nederlands tijdschrift voor geneeskunde
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A 19-year-old woman with a Syrian background complained of genital ulcers. Sexually transmitted disease was excluded. She was also suffering from oral aphthae and had been treated by a dermatologist for acne. ⋯ This often makes its diagnosis difficult. Its exact cause is unknown but the immune system and genetic factors may play a role. Although diagnosis is made mainly on clinical grounds, laboratory tests and pathology examination may contribute to the establishment of the differential diagnosis.
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Ned Tijdschr Geneeskd · Jan 2011
[Population-based breast cancer screening is not worthwhile. Screening has little effect on mortality].
Comparison of breast cancer mortality between pairs of similar countries (Sweden and Norway, Northern Ireland and the Irish Republic, the Netherlands and Belgium or Flanders), each of which had implemented its population-wide breast cancer screening programme at a different point in time, demonstrated little effect of screening on mortality. In the Netherlands, a well-organised population-wide screening programme was started in the early nineties, ten years before such a programme was introduced in Flanders. We used the 1989-1992 period as a baseline and compared breast cancer mortality in the Netherlands with that in Flanders during the 2005-2008 period. ⋯ A total of 5000 screening mammograms were needed to prevent one death from breast cancer. Breast cancer screening is not a public health priority. Impartial and transparent information on the disadvantages and benefits of breast cancer screening is urgently needed.
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Ned Tijdschr Geneeskd · Jan 2011
Comment[Effect of emergency intervention team still unclear. More evidence is necessary].
Changes in health care culture are accompanied by a flood of initiatives with respect to patient safety and quality of care. These initiatives are incentives from government, laymen press, health insurance companies and health care providers. ⋯ A medical emergency team (MET), also referred to as a rapid response team (RRT), is an example of a good initiative to improve health care quality that is being embraced rapidly worldwide, but solid evidence of its effectiveness is lacking. The number of cardiopulmonary arrests seems to have decreased, but adequate correction for case mix confounders has not been done and the effect on patient outcome, i.e. in-hospital mortality, has not been convincingly demonstrated.
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Ned Tijdschr Geneeskd · Jan 2011
Case Reports[Bicycle spoke-related injuries in children: emphasise prevention].
Three children, a 6-year-old boy and two girls aged 5 and 4 years, were seen at an emergency department due to distal lower-leg injuries sustained from the spokes of bicycle wheels. All three patients had been passengers on rear carrying seats of moving bicycles. Only the third bicyclist had used a special child safety seat. ⋯ Not only physical complications but also psychological ones can occur. The latter are often overlooked but do deserve proper treatment. The physician treating a spoke-related injury is in a good position to advice parents as to preventive measures, particularly on the use of special child safety seats.
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Primary torsion of the omentum majus is a rare condition. The clinical picture can mimic other causes of acute abdominal pain. The condition is therefore often not recognised and the diagnosis is made only perioperatively. ⋯ In any patient with episodes of recurrent, localised, stabbing abdominal pain, possibly related to exercise and without any other clear diagnosis, the diagnosis 'torsion of the omentum majus' should be considered.